Post traumatic complete facial nerve palsy

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Post traumatic complete facial nerve palsy

  1. 1. Post traumatic complete facial nerve palsy… is conservative management appropriate? DR MADAN GUPTA- ENT AIIMS DR ALOK THAKAR- ENT AIIMS DR DEEPAK AGRAWAL-NREUROSURGERY AIIMS DR ATIN KUMAR-RADIODIAGNOSIS AIIMS
  2. 2. • The recommened treatment for post traumatic complete facial nerve paralysis has generally been surgical .  Farrior and Caldwell - New Orleans Med Sci J.1947;100:23–25  Tucker and McCabe Laryngoscope. 1978;88:348 –354  Tuncay Ulug American Journal of Otolaryngology–Head and Neck Medicine and Surgery 26 (2005) 230– 238 • Some recent realization in the literature that surgical decompression for such injuries may not be always indicated. R13.pdf
  3. 3. MATERIAL AND METHOD Single arm Observational study Cohort of 35 consecutive cases of post- traumatic complete facial nerve palsy ( H& B grade VI) secondary to blunt head injury including cases with demonstrable fractures of the temporal bone. 2010-2012. , AIIMS main hospital and trauma centre Prospective study
  4. 4. Informed consent- discussed treatment options and also of the surgical option. 35 pateints were recurited 7 withdrew from the study Inclusion criteria Post traumatic grade VI facial palsy No response on ENoG Details of evaluation techniques
  5. 5. • Intervention- steroids 1mg kg /body weight/ -21 day tapering over 15 days and physiotherapy. • Ongoing observation did by close follow up with EMG. • Failure of clinical recovery by 4 months or any signs of nerve degeneration as noted on EMG designated as indications for surgical treatment.
  6. 6. 0 20 40 32 3 0 10 20 30 >20 20-40 40-60 4 21 10 AGE ONSET OF PALSY
  7. 7. RESULT-28/35(H & B GRADING) (2 DENIED FOR ENROLLMENT 5- LOST F/U ) INITIAL EVALUATION 3month 6month 9month 0 5 10 15 20 25 30 GRADE 5,6 GRADE 3,4 GRADE 1,2 28 1 23 4 1 27 1 27
  8. 8. INITIAL EVALUATION AFTER 4 MONTH
  9. 9. Conclusion  Longitudinal # remain the most common fracture in post traumatic facial our experience indicates that surgical need not be the only recommneded treatment.. In Post traumatic facial palsy treatment of choice can be conservative with close follow up and monitoring with nerve conduction test.

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